Healthcare Provider Details

I. General information

NPI: 1902715311
Provider Name (Legal Business Name): HANNAH GRACE LAVERY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 RUCCIO WAY STE 190
LEXINGTON KY
40503-3566
US

IV. Provider business mailing address

90 HOWARD DR
SHELBYVILLE KY
40065-8138
US

V. Phone/Fax

Practice location:
  • Phone: 859-279-0252
  • Fax: 859-406-5939
Mailing address:
  • Phone: 859-279-0252
  • Fax: 859-406-5939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: